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Myra McGuinness, Amalia Karahalios, Robert Patrick Finger, Robyn H Guymer, Allison Hodge, Graham Giles, Liubov D Robman, Julie Simpson; Late Age-related macular degeneration is associated with increased mortality. Invest. Ophthalmol. Vis. Sci. 2016;57(12):22.
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© ARVO (1962-2015); The Authors (2016-present)
Age-related macular degeneration (AMD) is the leading cause of severe, irreversible visual loss in older adults. Evidence supports theories of shared etiological pathways for AMD and systemic disease however evidence for an association with mortality remains inconclusive. We investigated the association of early and late AMD, including choroidal neovascularization (CNV) and geographic atrophy (GA), with all-cause and cardiovascular mortality in a prospective community based cohort study.
Color fundus photographs taken between 2003 and 2007 were assessed for AMD for 20,797 participants enrolled in the Melbourne Collaborative Cohort Study (aged 47-85, 60% female). Mortality data were obtained through linkage with the National Death Index up to December 31, 2012. Cox regression was used to investigate all-cause and cardiovascular mortality adjusting for age, sex, smoking status, country of birth, education, and diet. Separate models were fitted for AMD (no AMD, early AMD, late AMD), CNV and GA.
Early and late AMD were detected in 6,880 and 118 participants respectively. CNV and GA were present in 55 and 87 participants respectively including 20 who had both. A total of 1,622 deaths occurred, including 372 from cardiovascular causes, during a median follow-up period of 8.1 years. No association was detected between early AMD and all-cause (hazard ratio (HR) 0.99, 95% CI 0.89-1.10) or cardiovascular mortality (HR 0.91, 95% CI 0.73-1.15). Compared to those with no AMD, those with any late AMD were estimated to have a 49% increased risk of all-cause mortality (HR 1.49, 95 CI 1.06-2.09). In separate models, the risk of all-cause mortality was greater for those with CNV compared those with no CNV (HR 1.70, 95% CI 1.06-2.75) and for those with GA compared with those with no GA (HR 1.55, 95% CI 1.05-2.29).There was weak evidence of an increased risk of cardiovascular mortality for those with any late AMD (HR 1.75, 95% CI 1.00[MM1] -3.09). The risk of cardiovascular mortality was estimated to be more than three times greater in participants with CNV compared with those with no CNV (HR 3.21, 1.65-6.25) but evidence was not conclusive for those with GA (HR 1.68, 95% CI 0.86-3.29).
Late AMD is associated with increased all-cause and cardiovascular mortality suggesting shared pathways between AMD and systemic disease. CNV and GA show differing levels of association with cardiovascular mortality.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
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